I think and work better when my desk is tidy and ordered. I sleep better when my bedroom is tidy and clutter free. Does having streamlined, organised, ‘clutter free’ paperwork make a difference to how well we work in delivering personalised services?
Our paperwork shows up the worst excuses of organisations. We are afraid to throw information away incase CQC suddenly require it or a court case suddenly requests it. We keep so much more information about peoples behaviours, risk and health, than we do about what matters to people supported and what we appreciate about them.
I learned this afresh when I was working with a provider organisation who wanted to make their paperwork more person-centred.
Here are two illustrations of why this matters so much. Pauline talks about how as a manager, she was the ‘last man standing’ who could cover a sleep in shift at short notice.
"I had to cover a shift in an emergency last week." Pauline, one of the managers told me, "It took me well over an hour to read the lifestyle file and find the information I needed to know how to support him." (Watch here)
Any agency staff would have the same problem.
Similarly, Michelle, another manager having to cover a shift in an emergency, talks about the negative impact on the person of not having the right up to date person-centred information to know how to support the person well (watch here). So not having the right person-centred information that tells you what you need to know, or having so much cluttered information that it is impossible to find the information you need quickly – vital.
Sometimes it could mean life or death. Commissioner Kim Haworth is so concerned that staff in residential care don’t have easy, quick access to vital support information, that she is working with safeguarding colleagues and providers to introduce one-page profiles for everyone.
I started to explore this with a provider where each person has two large lever arch files for everyone they support, one containing lifestyle information, and the other personal data (GP name and address etc).
So here is the dilemma - how can we have paperwork that tells you who the person is, and how you need to support them, and still meet all the regulatory requirements?
Together with their managers, we came up with the following headings/categories for the lifestyle paperwork.
Information that informs what staff do on a day to day basis.
- One page profile (a summary of the person)
- What is important to the person
- Important in the future (aspirations)
- How best to support the person
- The person’s history (this is important to have a record of but would not be used on a daily basis
Information that staff record daily/as required
- Learning Logs
Actions and Learning
- What is working and not working from different perspectives
- Actions - who is doing what by when, and progress on this
- Questions to answer
Reference material
- This information is filed somewhere else, but can be retrieved easily if required.
For many of you this will look very familiar - they are the headings from the person-centred review process. This means that every time there is a person-centred review, it should be easy to add and update the file.
The file begins with a one-page profile, almost as an 'executive summary'. If you only have five minutes to read about the person before supporting them, this is what you need to have.
Everyone that they support has several assessments in the lifestyle lever-arch file. These include OT assessments, behaviour assessments, risk assessments etc. As I understand it from being an OT, the purpose of the assessment is to find out where someone is now, and work out what needs to happen to achieve positive change.
The assessment gives a base-line to demonstrate progress and should inform how staff support people. Therefore, we should take the information that tells staff how to support the person well and put this under the 'How to support the person' section of the file.
For example, we expect 'behaviour plans' to tell us something about how staff need to support the person, and often this information can be put into a communication chart (at this time/when the person does this/we think it means/and we should). The assessment itself can then be filed somewhere else, clearly indexed in the lifestyle file, so that people could find it when they want it.
"Won't that be a lot of work - going through each file, and assessment, and pulling out the relevant information about how to support the person?" asked Judy.
I started buy putting my money where my mouth is and took two of those lever arch files home with me (with the person’s permission).
Armed with a highlighter pen I went through 300 pages of filed information. I used the highlighter pen to identify the person-centred information that went under the headings I mentioned earlier. Then everything was either filed or recycled. The final version was 15 pages of person-centred easy to use information. This took me an hour and a half, and then there was an hour of typing to pull the end result together, (and a bag full of paper to recycle!).
The answer was yes, it does take a while, but it made a powerful difference because we need to compare that to the hour that it takes people to find the relevant information in the file at the moment. Frankly, what they have at the moment makes it less likely, rather than more likely, that staff can support people in a person-centred way.
To put this in to practice in the organisation, we had a day together – a working day not a training day, with all of the managers. Each manager brought the files for two people they supported. I explained the headings, and showed people how I had done it, and then we did it together, file by file. The senior managers were in the room, so that managers could check if they were unsure whether they could throw something away or whether it should be filed.
At the end of the day, there were three boxes full of paper to be recycled, and many managers said they left feeling lighter too. You can watch two of those managers reflect on their day here.
How are you managing the challenge of your paperwork reflecting your values, and complying with regulations as well? Please let us know and share your comments.
